Nurse uses Wellbutrin to cut back on cigarettes

Q: I am a nurse who has smoked for 17 years. I used to enjoy it. As a single mom, smoking sometimes felt like my only friend.

Now I hate it. I get embarrassed lighting up in public, and I hate to think of the amount of money I have spent not only on cigarettes but also on body sprays, air fresheners, teeth whiteners, etc.

I tried Chantix when it first came out, and it was horrible. I had nightmares and suicidal thoughts, and I didn’t care about anything. I thought smoking was better than these side effects.

This time around I started Wellbutrin, which is equivalent to Zyban. It has been so much better. My mood has been on an even keel. It’s been a week, and I am down to four a day.

A: We congratulate you on trying to quit smoking. It is one of the most important things you can do for your health.

Bupropion (Wellbutrin, Zyban) is prescribed to help people stop smoking. It may take two to three months of treatment to overcome the habit. Bupropion also is prescribed for depression, which might explain your stable mood.

Q: I have Type 2 diabetes and took Januvia for six weeks. I had severe muscle and joint pain and terrible nausea. I couldn’t get out of bed in the morning because this medicine made me feel like I was dying. I stopped taking it and wonder how else I can control my blood sugar.

A: The Food and Drug Administration has warned about severe and disabling joint pain associated with sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). There are many other approaches to controlling blood sugar in Type 2 diabetes.

In our “Guide to Managing Diabetes,” we discuss dietary choices that can be useful as well as herbs and medications to lower blood sugar. It is available at PeoplesPharmacy.com.

Herbs that may be helpful include bitter melon, cinnamon, fenugreek and nopal cactus. You also may want to discuss metformin or an old drug like glyburide with your physician.

Q: Shortly after I was diagnosed with prostate cancer, my urologist prescribed dutasteride (generic for Avodart) to shrink my enlarged prostate. He thinks that a smaller, more condensed treatment site might improve my outcome.

Within a week of starting dutasteride, I was engulfed by severe depression — a sense of hopelessness I had never experienced before. I became extremely irritable, lost interest in my usual activities and didn’t feel like pursuing any treatment options.

I’ve experienced depression before and always managed to work through those episodes. What I felt on this drug was nothing like what I had dealt with in the past.

Within days of stopping dutasteride, I was back to normal. Am I concerned about having cancer? Sure, but I don’t feel hopeless or overwhelmed as I did on the drug.

I read up on dutasteride, but I didn’t see severe depression as a possible side effect in clinical trials. Is there any research on this problem?

A: Dutasteride (Avodart) and finasteride (Proscar) are prescribed for men with enlarged prostate glands that interfere with the flow of urine. You are correct that the clinical trial data don’t reveal depression as an adverse effect of these drugs.

Information collected after FDA approval, however, does show that some men experience depression as a side effect. A more recent study confirms that men taking either of these medicines are more likely to report depression or self-harm (JAMA Internal Medicine, May 1, 2017).